Prognostic value of biomarkers in heart failure application of novel methods in the community

Shannon M Dunlay, Yariv Gerber, Susan A. Weston, Jill M. Killian, Margaret May Redfield, Veronique Lee Roger

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Background-Mortality among patients with heart failure is high. Though individual biomarkers have been investigated to determine their value in mortality risk prediction, the role of a multimarker strategy requires further evaluation. Methods and Results-Olmsted County residents presenting with heart failure from July 2004 to September 2007 were recruited to undergo biomarker measurement. We investigated whether addition of C-reactive protein, B-type natriuretic peptide, and troponin T to a model including established risk indicators improved 1-year mortality risk prediction using the c statistic, integrated discrimination improvement, and net reclassification improvement. Among 593 participants, the mean age was 76.4 years, and 48% were men. After 1 year of follow-up, 122 (20.6%) participants had died. Patients with C-reactive protein (<11.8 mg/L), B-type natriuretic peptide (<350 pg/mL), and troponin T (≤0.01 ng/mL) less than the median had low 1-year mortality (3.3%), whereas those with 2 or 3 biomarkers greater than the median had markedly increased mortality (30.8% and 35.5%, respectively). The addition of 2 or more biomarkers to the model offered greater improvement in 1-year mortality risk prediction than use of a single biomarker. The combination of C-reactive protein and B-type natriuretic peptide resulted in an increase in the c statistic from 0.757 to 0.810 (P<0.001), an integrated discrimination improvement gain of 7.1% (P<0.001), and a net reclassification improvement of 22.1% (P<0.001). Use of all 3 biomarkers offered no incremental gain (integrated discrimination improvement gain 0.7% versus C-reactive protein+B-type natriuretic peptide, P=0.065). Conclusions-Biomarkers improved 1-year mortality risk prediction beyond established indicators. The use of a 2-biomarker combination was superior to a single biomarker in risk prediction, though addition of a third biomarker conferred no added benefit.

Original languageEnglish (US)
Pages (from-to)393-400
Number of pages8
JournalCirculation: Heart Failure
Volume2
Issue number5
DOIs
StatePublished - Sep 2009

Fingerprint

Heart Failure
Biomarkers
Brain Natriuretic Peptide
Mortality
C-Reactive Protein
Troponin T
Peptide T
IgA receptor

Keywords

  • Community
  • Epidemiology
  • Heart failure
  • Inflammation
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Prognostic value of biomarkers in heart failure application of novel methods in the community. / Dunlay, Shannon M; Gerber, Yariv; Weston, Susan A.; Killian, Jill M.; Redfield, Margaret May; Roger, Veronique Lee.

In: Circulation: Heart Failure, Vol. 2, No. 5, 09.2009, p. 393-400.

Research output: Contribution to journalArticle

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abstract = "Background-Mortality among patients with heart failure is high. Though individual biomarkers have been investigated to determine their value in mortality risk prediction, the role of a multimarker strategy requires further evaluation. Methods and Results-Olmsted County residents presenting with heart failure from July 2004 to September 2007 were recruited to undergo biomarker measurement. We investigated whether addition of C-reactive protein, B-type natriuretic peptide, and troponin T to a model including established risk indicators improved 1-year mortality risk prediction using the c statistic, integrated discrimination improvement, and net reclassification improvement. Among 593 participants, the mean age was 76.4 years, and 48{\%} were men. After 1 year of follow-up, 122 (20.6{\%}) participants had died. Patients with C-reactive protein (<11.8 mg/L), B-type natriuretic peptide (<350 pg/mL), and troponin T (≤0.01 ng/mL) less than the median had low 1-year mortality (3.3{\%}), whereas those with 2 or 3 biomarkers greater than the median had markedly increased mortality (30.8{\%} and 35.5{\%}, respectively). The addition of 2 or more biomarkers to the model offered greater improvement in 1-year mortality risk prediction than use of a single biomarker. The combination of C-reactive protein and B-type natriuretic peptide resulted in an increase in the c statistic from 0.757 to 0.810 (P<0.001), an integrated discrimination improvement gain of 7.1{\%} (P<0.001), and a net reclassification improvement of 22.1{\%} (P<0.001). Use of all 3 biomarkers offered no incremental gain (integrated discrimination improvement gain 0.7{\%} versus C-reactive protein+B-type natriuretic peptide, P=0.065). Conclusions-Biomarkers improved 1-year mortality risk prediction beyond established indicators. The use of a 2-biomarker combination was superior to a single biomarker in risk prediction, though addition of a third biomarker conferred no added benefit.",
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